Question 1

The nurse is tending to a new client who has made several suicide attempts. The client reports having persistent, strong suicidal intentions. Which intervention by the nurse is most appropriate while still promoting a therapeutic hospital environment?

A) The nurse supervises the patient at all times by seating the patient alone at meal times
B) The nurse allows the patient to have unsupervised free time to visit with other group members.
C) The nurse removes any potential tools for self-harm from the patient's room and keeps the door locked.
D) The nurse brings the patient to impromptu group therapy sessions so the patient is never alone for long periods of time.

Accepted Answer

It is important to prioritize safety when dealing with a client who has persistent, strong suicidal intentions. Removing any potential tools for self-harm from the patient's room and keeping the door locked can help ensure the safety of the client while still promoting a therapeutic hospital environment. Seating the patient alone at meal times or bringing the patient to impromptu group therapy sessions can be helpful interventions, but they do not necessarily address the immediate safety concerns. Allowing the patient to have unsupervised free time to visit with other group members would not be safe in this situation.

Question 2

A client on an inpatient unit angrily says to a nurse, &#34;Peter is not cleaning up after himself in the community bathroom. You need to address this problem.&#34; Which is the appropriate nursing response?&#10;A) &#34;I'll talk to Peter and present your concerns.&#34;&#10;B) &#34;Why are you overreacting to this issue?&#34;&#10;C) &#34;You should bring this to the attention of your treatment team.&#34;&#10;D) &#34;I can see that you are angry. Let's discuss ways to approach Peter with your concerns.&#34;&#10;

Accepted Answer

Option D is the best response as it acknowledges the client's feelings and proposes a solution-oriented approach. It shows the nurse is willing to listen and work with the client to find a solution. Option A is also acceptable, but it does not address the client's emotions, which could escalate if not validated. Option B is dismissive and could escalate the situation. Option C places the responsibility on the client to address the issue, which may not be feasible or appropriate.

Question 3

A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. Which does the milieu provide that may be missing in the home environment?

A) Peer pressure
B) Structured programming
C) Visitor restrictions
D) Mandated activities

Structured programming

Accepted Answer

The milieu (or therapeutic environment) provides structured programming, which may be missing in the home environment. Having a structured routine and daily activities can help individuals with schizophrenia maintain stability and manage symptoms. Without this structure at home, the client may struggle to stay organized and engaged in healthy behaviors, leading to a decompensation. Peer pressure, visitor restrictions, and mandated activities may vary in their impact on a client's stability and would not necessarily be missing in the home environment.

Question 4

A scientific structuring of the environment in order to affect behavioral changes and to improve the psychological health and functioning of the individual is defined as ______ therapy.

Accepted Answer

The answer of A scientific structuring of the environment in...

Question 5

To promote self-reliance, how would a psychiatric nurse best conduct medication administration?&#10;A) Encourage clients to request their medications at the appropriate times.&#10;B) Refuse to administer medications unless clients request them at the appropriate times.&#10;C) Allow the clients to determine appropriate medication times.&#10;D) Take medications to the clients' bedside at the appropriate times.&#10;

Accepted Answer

Encouraging clients to request their medications at the appropriate times promotes self-reliance by giving them control over when they take their medication. However, it is important for the nurse to still ensure that medications are taken consistently and correctly. Refusing to administer medications or allowing clients to determine their own medication times may not be safe or appropriate for all clients. Taking medications to the clients' bedside at the appropriate times may still be necessary for clients who have difficulty managing their medication independently.

Question 6

An angry client on an inpatient unit approaches a nurse stating, "Someone took my lunch! People need to respect others, and you need to do something about this now!" Which response by the nurse responds would be guided by which basic assumption of milieu therapy?

A) "Let's find a way to avoid this conflict in the future."
B) "I'll fix this right away."
C) "I can see that you are upset. Let's talk about ways to resolve this."
D) "It would be best for you to bring this up during group therapy later this week."

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Accepted Answer

Milieu therapy is based on the assumption that the environment plays a significant role in the individual's behavior, and the goal is to create a therapeutic environment in which patients can learn healthier ways of interacting with others. The nurse's response acknowledges the patient's frustration and invites them to collaborate on finding a solution, which aligns with the principles of milieu therapy. Options A, B, and D do not address the patient's feelings or involve them in the problem-solving process.

Question 7

A newly admitted client asks, &#34;Why do we need a unit schedule? I'm not going to these groups. I'm here to get some rest.&#34; Which is the most appropriate nursing response?&#10;A) &#34;The purpose of group therapy is to learn and practice new coping skills.&#34;&#10;B) &#34;Group therapy is mandatory. All clients must attend.&#34;&#10;C) &#34;Group therapy is optional. You can go if you find the topic helpful and interesting.&#34;&#10;D) &#34;Group therapy is an economical way of providing therapy to many clients concurrently.&#34;&#10;

Accepted Answer

The purpose of group therapy is to provide a supportive environment where clients can learn and practice new coping skills, which is essential for their recovery and rehabilitation process.

Question 8

A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. Which would the nurse identify as an appropriate group topic?&#10;A) Dream analysis&#10;B) Creative cooking&#10;C) Paint by number&#10;D) Stress management&#10;

Accepted Answer

Stress management is an appropriate group topic for an inpatient psychiatric unit as many patients may be experiencing anxiety or stress related to their mental illness or hospitalization. Dream analysis or creative activities like cooking and painting may not be relevant or useful to all patients on the unit.

Question 9

Which of the following conditions promote a therapeutic community? (Select all that apply.)&#10;A) The unit schedule includes unlimited free time for personal reflection.&#10;B) Unit responsibilities are assigned according to client capabilities.&#10;C) A flexible schedule is determined by client needs.&#10;D) The individual is the sole focus of therapy.&#10;E) A democratic form of government exists.&#10;

Accepted Answer

Assigning responsibilities based on client capabilities and having a democratic form of government both promote a therapeutic community by encouraging participation, responsibility, and equality among clients.

Question 10

A client is to undergo psychological testing. Which member of the interdisciplinary team would a nurse consult for this purpose?&#10;A) The psychiatrist&#10;B) The psychiatric social worker&#10;C) The clinical psychologist&#10;D) The clinical nurse specialist&#10;

Accepted Answer

Clinical psychologists are mental health professionals specialized in the administration of psychological tests and assessments, making them the best choice for consultation when a client is to undergo psychological testing. Psychiatrists and clinical nurse specialists may also be involved in the assessment and treatment of mental health conditions, but their expertise does not typically include the administration of psychological tests. Psychiatric social workers are skilled in providing psychotherapy, but they do not have the same level of training in psychological assessment as clinical psychologists.

Question 11

Which scenarios reflect a therapeutic community, based on Skinner's seven basic assumptions?&#10;A) The nurse asks each patient to articulate a personal strength that they will focus on improving.&#10;B) When a patient is consistently late to group activities, the other group members ask that individual to be more punctual.&#10;C) A patient who behaves inappropriately is restricted from group activities for three months.&#10;D) A patient is encouraged to hang personal artwork above her bed.&#10;E) When group members ignore an individual's inappropriate behavior, the nurse respects their choice not to address it.&#10;

Accepted Answer

The answer of Which scenarios reflect a therapeutic community, based...

Question 12

A client who is newly admitted to an inpatient psychiatric unit reports that newly prescribed medication is exacerbating her anxiety and paranoia. The nurse is attending an interdisciplinary team meeting regarding the client. Which members of the interdisciplinary team would be able to alter this client's prescription? (Select all that apply.)

A) Psychiatric nurse
B) Psychiatrist
C) Psychiatric nurse practitioner
D) Psychiatric technician
E) Psychiatric social worker

Accepted Answer

The answer of A client who is newly admitted to...

Deck 7: Milieu Therapythe Therapeutic Community